A Diffusion Tensor Imaging-Based Prognostic Classification for Surgery of Intrinsic Lesions Involving the Motor Pathways.


Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Apr 2023
Historique:
received: 09 12 2022
revised: 18 01 2023
accepted: 19 01 2023
medline: 5 4 2023
pubmed: 28 1 2023
entrez: 27 1 2023
Statut: ppublish

Résumé

The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging-based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways. We included patients consecutively enrolled at our institution between April 2020 and September 2022 with 3 patterns of increasing complexity according to the relationship between the lesion and the corticospinal tract as identified on preoperative diffusion tensor imaging. Outcome measures were >50% reduction in intraoperative MEPs and neurological outcome defined as unchanged, improved, or worsened. The study included 83 patients. A statistically significant linear trend between higher rates of reduction of MEPs and higher classification grades was observed (P = 0.001), with sensitivity 0.60, specificity 0.88, accuracy 0.83, and area under the curve 0.75. Higher grades were associated with worse neurological outcomes (P = 0.02). The classification proved reliable in anticipating reduction in intraoperative MEPs and in predicting neurological outcome. Using this classification in patients undergoing surgery for lesions involving the motor pathways could help in counseling the patient, surgical planning, enhancing teamwork of operating room personnel, and improving the patient's prognosis.

Sections du résumé

BACKGROUND BACKGROUND
The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging-based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways.
METHODS METHODS
We included patients consecutively enrolled at our institution between April 2020 and September 2022 with 3 patterns of increasing complexity according to the relationship between the lesion and the corticospinal tract as identified on preoperative diffusion tensor imaging. Outcome measures were >50% reduction in intraoperative MEPs and neurological outcome defined as unchanged, improved, or worsened.
RESULTS RESULTS
The study included 83 patients. A statistically significant linear trend between higher rates of reduction of MEPs and higher classification grades was observed (P = 0.001), with sensitivity 0.60, specificity 0.88, accuracy 0.83, and area under the curve 0.75. Higher grades were associated with worse neurological outcomes (P = 0.02).
CONCLUSIONS CONCLUSIONS
The classification proved reliable in anticipating reduction in intraoperative MEPs and in predicting neurological outcome. Using this classification in patients undergoing surgery for lesions involving the motor pathways could help in counseling the patient, surgical planning, enhancing teamwork of operating room personnel, and improving the patient's prognosis.

Identifiants

pubmed: 36706980
pii: S1878-8750(23)00096-7
doi: 10.1016/j.wneu.2023.01.081
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e565-e573

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Giovanni Muscas (G)

Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy. Electronic address: muscasgi@aou-careggi.toscana.it.

Antonio Pisano (A)

Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy.

Riccardo Carrai (R)

SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, Careggi University Hospital, Florence, Italy.

Andrea Bianchi (A)

Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.

Federico Capelli (F)

Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy.

Vita Maria Montemurro (VM)

Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy.

Cristiana Martinelli (C)

SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, Careggi University Hospital, Florence, Italy.

Enrico Fainardi (E)

Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.

Antonello Grippo (A)

SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, Careggi University Hospital, Florence, Italy.

Alessandro Della Puppa (A)

Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy.

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